Elizabeth Tramonti

depression.jpg
Sadness, from Disney-Pixar's Inside Out
In Impact of Anxiety and Depression Symptoms on Scholar Performance in High School and University Students (discussed under Professional & Scholarly Articles), depression is defined as being characterized by “anhedonia (incapacity to experiment pleasure) as a central symptom but also includes episodes of irritability, anxiety and fear, in addition to alterations in appetite, body weight, sleep and motor efficiency—all accompanied by low self-esteem, guilt and the idea of death that predispose to suicide risk.” The most common of mental health problems in America, it attacks students, leaving them barely able to complete basic tasks. A compilation of articles highlights the problems and proposes several methods for how educational faculty and staff can make a difference in the lives of their suffering students. A modest proposal for a comprehensive plan for the State of Rhode Island follows. While those with depression suffer their entire life, early intervention and sympathetic understanding can give adolescents lessons that will help them achieve their dreams.


Articles

Opinion Articles

Depressed, but Not Ashamed

Halpert, M., & Rosenfeld, Eva. (2014, May 22). Depressed, but Not Ashamed. New York Times, p. A29.

Young high school students Madeline and Eva express their outrage after being told they couldn’t run a series of articles in their school newspaper about the mental health problems – depression, anxiety, eating disorders, etc. – their fellow students face. Hoping to bring awareness to, and erase the shame and embarrassment many can feel from having one of these disorders, they feel as if the students’ voices are being suppressed. Both point out in their article that eleven percent of teenagers have some form of depression before they turn eighteen and that suicide is the third leading cause (with untreated depression leading the charge) of deaths in people aged ten to twenty-four. The principal – with the consultation of a medical health professional – believes that not only would the articles violate students’ privacy rights but would potentially cause students to be bullied or suffer relapses. All that Madeline and Eva say they want is the chance to erase the stigma from mental illness and offer the chance for fellow students to gain acceptance for who they really are – warts and all.

What’s most interesting in the case of these two brave students? They are attempting a student-driven positive change. Despite many administrators’ mild attempts to raise awareness, most students in RI schools are not “loud and proud” about having a mental illness or even trying to provide support and acceptance for those students who do. In encouraging students to be more open about their experiences (without violating HIPAA, of course), could we create a more tolerant environment for those students who experience debilitating depression?

Teenage Depression: They Spoke Out

Teenage Depression: They Spoke Out. (2014, May 30). New York Times, p. A26.

A flood of letters were published in the NY Times responding to Madeline and Eva’s scathing indictment of the administration’s reaction to their proposed article series. Out of five letters – running the gamut from a teacher at the school to the National Executive Director of the Alliance on Mental Illness and two authors – only one correspondent (or about 20% of the replies) believed that the principal was in the right. Mary Giliberti (the Director of NAMI) cites that “fifty percent of all lifetime cases of mental illness begin by [the age of] fourteen…” and encourages the two teens to continue their crusade. While Rob Longley applauds their efforts, he believes that Madeline and Eva’s denunciation of their principal is unfounded and that, further, the school is already doing plenty to support students with mental health issues. It can be highly therapeutic for teenagers to be heard about their problems – most especially by their peers – states Arden Greenspan-Goldberg, author of What Do You Expect? She’s a Teenager! Bea Tusiani (author of Remnants of a Life on Paper) tenders the hope that somewhere in the future, school nurses will begin to keep the pulse of students’ mental health as well as their physical.

Reading the reactions is almost more informative – and more thought-provoking – than the original article. Ms. Greenspan-Goldberg reiterates Madeline and Eva’s original point: that being heard, especially by one’s peers, can be highly therapeutic and enhance the adolescent experience. Especially intriguing are Ms. Tusiani’s thoughts about monitoring student mental health at the school level. While the ObamaCare Act would ideally allow families access to a variety of healthcare services, including mental health professionals, many families are slipping through the cracks. School can provide many services to students who would otherwise go without. Why shouldn’t that include resources such as therapy and evaluation? Providing nurses or psychologists in schools could, in fact, save lives.

Analysis Articles

Teen Health: Depression, anxiety and social phobias rising in kids, educators say

Noguchi, S. (2015, February 5). Teen health: Depression, anxiety and social phobias rising in kids, educators say. Retrieved from http://www.mercurynews.com/health/ci_25074044/teen-health-depression-anxiety-and-social-phobias-rising

Students' mental health issues are on the rise in Silicon Valley. Despite a current lack of funded research, it is apparent that the increase in reported cases is not specific to family income or place in the social hierarchy, race or nationality, or academic ability. Noguchi's studies contain some chilling statistics. “Statistics from the National Institute of Mental Health indicate that the incidence of teen mental illness was stable for 10 years through the early 2000s, the latest data available. Those surveys show that 25% of teens have suffered anxiety at some time in their lives, 11.2% major depression and 2.4% agoraphobia.” Major depression is the very stereotype of melancholia: a complete inability to proceed with life as normal, including eating, sleeping, studying, or spending time with friends. Depression is also being found in students that are younger and younger - one of the schools in the area hired a therapist to assist depressed fourth- and fifth-graders. Many high school students are hampered in their access to aid by the social stigma that accompanies the detection of mental illness as well as their parents' refusal to accept their child's medical problem. (Some parents cited concerns that having their child officially diagnosed would harm their chances at certain universities, future jobs, etc.) The Northern Californian school district is fighting to provide students with access to overcome these problems on several fronts. Trained teachers and therapists are now helping adolescents in the schools. Special classes for those with depression, anxiety, and other problems are being tested in certain schools - and are consistently full. A club at Los Altos High, called Let's Erase the Stigma (or LETS), is trying to teach students that not only is it alright to be mentally ill, but to ask for help and recognize the signs within themselves before it becomes too late.

The upswing in mental health problems with children can be frightening. What is occurring in the teenagers of Silicon Valley can be found, duplicated, here in Rhode Island. Our state should look to the success of programs being offered in California – and similar programs offered elsewhere – to offer high school students the same opportunities to be healthy. A supportive environment, mental health screenings, and certified specialists could go a long way towards teaching students life lessons about how to stay self-reliant and safe.

Depressed teens mostly struggle alone

Healy, M. (2011, April 29). Depressed teens mostly struggle alone. Los Angeles Times. Retrieved from http://articles.latimes.com/2011/apr/29/news/la-heb-depressed-20110428

The USA’s Substance Abuse and Mental Health Services Administration found that about two million American adolescents experienced a major depression episode within the year – but only a third request help. 15% of high school students have self-reported “seriously contemplating suicide” within the year. Around 150,000 students between the ages of ten and twenty-four need emergency care for self-inflicted injuries; about 4,400 commit suicide. Nine out of ten of those suicide victims have been found to suffer from a diagnosable mental illness at the time of their passing – and 63% displayed overt symptoms. Of the population between twelve and seventeen years old, 8.1% described experiencing a major depressive episode. Sadly, it is more likely that adolescents will experience one as they grow older. While 15% of girls ages fifteen to seventeen underwent an incident, they were more likely than their 6.4% male counterparts to communicate their problem and ask for assistance – a trend that continues into adulthood. Based on a national survey of drug use and health administered in 1009, those that “experienced depression were…more likely to have abused prescription drugs in the past month than those who were not depressed (19.2% vs. 6.6%), to smoke cigarettes daily (3.6% vs. 1.9%), and to report heavy alcohol use in the preceding month (4.2% vs. 1.9%).” Only 34.7% of those who revealed their struggle with depression admitted receiving treatment within the year; of those, 58.5% said they had consulted a professional about it, but weren’t taking medicine; 6.7% took a prescription, but didn’t seek the help of a professional; and 34.7% saw someone in combination with a pharmaceutical treatment. Fortunately, these findings were presented with the announcement of some preventative measures. Massachusetts requires all primary care physicians to screen adolescents under Medicaid for mental health problems; the Society for Adolescent Medicine, the American Academy of Pediatrics, and the American Academy of Family Physicians recommend constant screening for early signs of a problem; and Columbia University’s Teen Screen program is offered (with parents’ permission) at over five hundred fifty schools and is commonly used to identify higher-risk youth.

This article really underscores the need for screenings and early intervention, as depressed youth are not only at a risk for self-harm but other destructive behaviors (i.e. underage drinking, drug use, etc.). (And once these adolescents have reached the threshold of self-medication, how do we save them?) It would be easy to introduce the Teen Screen to Rhode Island’s public educational institutions – much like Bea Tusiani’s proposal to have school nurses keep a “pulse” on students’ mental health. Early intervention programs can provide a solid foundation to educate students with depression and other problems on how to survive with their issues.

Summary Article

Impact of Anxiety and Depression Symptoms on Scholar Performance in High School and University Students

Bernal-Morales, B., Rodriguez-Landa, J. F., & Frank Pulido-Criollo. (n.d.). Impact of Anxiety and Depression Symptoms on Scholar Performance in High School and University Students. In A Fresh Look at Anxiety Disorders (pp. 225–242). Retrieved from http://cdn.intechopen.com/pdfs-wm/48585.pdf

Despite the stereotype of goth teenagers always crying and writing sad poetry, teenage depression doesn’t generally exhibit itself as sadness. Adolescents exhibit irritability, an inability to experience pleasure (anhedonia), suicidal tendencies, hypersomnia or insomnia, and cognitive issues. Boys are more likely to be anhedonistic, while girls display more cognitive and somatic issues. However, both genders display asocial behaviors and display negative self-concepts, including harsh self-judgment, low self-esteem, and pessimism. “Depression is considered disabling, even more than physical illness, in a social context in daily activities or otherwise productive tasks…” Studies show that depression degrades academic achievement, but stress from studies doesn’t impact depression. In thirteen- to seventeen-year olds, the severity of depression directly influences concentration, social relationships, self-achievement, academic performance, and reading and writing ability. Teachers, parents, and students must work together to catch symptoms and teachers especially must remember to treat depression as an illness – and adjust expectations accordingly.

This article succinctly expresses the thesis: that depression – which is not caused by stress – adds to it immensely and hinders students’ success. A vicious cycle ensues, where the student does poorly in a class because of their mental health issue; depression leads them to berate themselves; their depression worsens, effectively cutting them off from outside support and debilitating them; which in turn influences their grades. While it doesn’t further the proposed Mental Health Strategy at the end of this treatise, it provides teachers with benchmarks to look for.

Professional and Scholarly Articles

Learn How to Recognize and Help Depressed Students

McMullen, L. (2012, January 18). Learn How to Recognize and Help Depressed Students. U.S. News Education. Retrieved from http://www.usnews.com/education/blogs/high-school-notes/2012/01/18/learn-how-to-recognize-and-help-depressed-students

One-fifth of girls between fourteen and seventeen claim that they have felt “severely depressed” in their lifetime. 21% of high school girls have experienced a Major Depressive Episode at one point in their lifetime, with only 10% of boys reporting the same. However, boys are much more likely to have high-risk behaviors, like physical fighting, driving under influence of drugs or alcohol, or carrying a weapon. Depression can be exacerbated by the maelstrom of high school experiences, including identity development, shifting support systems, as well as the pressure of academia. Teachers should not only “keep an eye out” for troubling behaviors but should encourage one-on-one conversations and potential parental involvement.

Much like mental health screenings, intervention from teachers and other faculty can facilitate proper care for the student. It would require intensive training on the warning signs and proper handling techniques for the teachers but would be very effective, as they interact with their students daily.

Responding to a Student's Depression

Crundwell, R. M. A., & Killu, K. (2010). Responding to a Student’s Depression. Educational Leadership, 68(2), 46–51.

Two of the most important figures from the article are verbatim as follows:

Fig 1.
Characteristics of Depression
in Adolescents
What It Looks Like in School
Decreased self-esteem and feelings of self-worth
Self-deprecating comments
Mild irritability
Defiance with authority figures, difficulties interacting with peers, argumentativeness
Negative perceptions of student's past and present
Pessimistic comments, suicidal thoughts
Peer rejection
Isolation, frequent changes in friends
Lack of interest and involvement in previously beloved activities
Isolation and withdrawal
Boredom
Sulking, noncompliance
Impulsive and risky behavior
Theft, sexual activity, alcohol or drug use, truancy
Substance abuse
Acting out of character, sleeping in class
Fig 2.
Strategies to Help Students with Depression

Frequent feedback on social, academic, and behavioral performance.
Teach the student how to set goals and self monitor.
Coach the student in ways to organize, plan, and execute tasks demanded daily or weekly in school.
Develop modifications and accommodations to respond to the student's fluctuations in mood, ability to concentrate, or side effects of medication. Assign one individual to serve as primary contact and coordinate interventions.
Give the student opportunities to engage in social interactions
Frequently monitor whether the student has suicidal thoughts.
Develop a home-school communication system to share information on the student's academic, social, and emotional behavior and any developments concerning medication or side effects.
There are other important actions for working with a depressed student. A touchstone teacher, or someone the student meets with to help maintain and track his or her goals, helps build self-management – imperative for someone who experiences MDEs. Classroom teachers can teach healthy study strategies, such as self-care (including break-times) and learning methods, during their period. Group activities should be scheduled and maintained to help alleviate stress. Other helpful ideas include strong parent-school communication and a no-suicide contract, where the student promises to contact the adults specified in case of suicidal ideation.

Effective teaching for students suffering from depression involve a personalized combination of these techniques. “Personalization” is the by-word of the Rhode Island Department for Education, who have promised intensely personalized curricula by 2020. By offering students extra life skills lessons and individual attention, educators give them the tools to live with depression - without having it control their life.

Blog Post

Talking to the School About Your Child’s Depression

Talking to the School About Your Child’s Depression: An Excerpt from the Parent Handbook on Childhood and Adolescent Depression. (2015, August 21). [Blog]. Retrieved from http://www.erikaslighthouse.org/blog/talking-school-childs-depression-excerpt-parent-handbook-childhood-adolescent-depression/

Parents should consider telling teachers, advisors, the school nurse, and one or more of the school’s mental health staff, as all of them play an important role on their children’s daily lives. Pertinent information can include “the appropriate facts about your teen’s illness, treatment they are receiving, your thoughts on the ramifications of the illness for your child’s progress at school and your ideas about any changes or adjustments your child may need at school” as well as any social problems they are experiencing. If your adolescent is currently seeing a therapist, allowing direct contact between them may serve your student well.

Despite teens’ eager reassurances that parents-need-not-be-involved, it is imperative (as other sources have said) there be a strong parent-teacher connection. Parents, benefitting from evenings and weekends with their children, can offer advice and information to the school about them. This information can ensure the student receives the best, individualized care possible.


Overall Reaction to Your Research
Depression is a common problem, as 11.2% of the population experiences it – with 15.2% of teenaged females and 6.4% of teenaged males reporting a major depressive episode within the year. About fifty percent of adolescents will experience symptoms before they turn fourteen, with growing numbers of fourth- and fifth-graders seeking treatment. Those who have depression experience cognitive and socio-emotional difficulties, including lowered concentration, poor academic performance, and difficulty connecting with peers. Yet while this terrible illness can complement and increase students’ stress, stress cannot cause depression – thus, lowering or eliminating other influences, such as academic workload or bullying, will not reduce or negate it. Adolescent pupils request support groups, one-on-one mentoring, specialized classes, and modified assignments. While teachers are not currently mandated to receive training in how to recognize danger signs or implement plans for depressed students, early intervention from faculty and staff can prevent risky behaviors and enhance teenagers’ quality of life. Inasmuch as depression is the biggest mental illness – and one of the leading causes for death in students ages ten to twenty-four – we must take every precaution and measure to ensure that students who suffer from it are given the tools to succeed.

How does this research help us identify or refine a strategy to improve schools in Rhode Island?

Rhode Island’s Strategic Plan should rest on three legs: parents, faculty and staff, and students.

Faculty and Staff:
  • Receive mandatory training on how to identify students with depression and how to help them.
  • Implement the Teen Screen, or a similar program, in the school.
  • Modify lesson plans and assignments to fit the daily needs of the students – either with the help of a TA or themselves
  • Offer specialized classes for those with mental health struggles, where they can learn homework in a supportive environment and receive the extra attention they need
  • Allow modifications of classroom rules to support the student
  • Mentor a student with depression; help them set daily and weekly goals in terms of academics
  • Stay in touch with parents and other faculty and staff to receive updates on the child’s behavior and emotional state
  • Mandatory reporting: report if students’ depression is leading to self-harm or other risky behaviors

Students:
  • Must sign a No-Suicide Contract
  • Must meet with their mentor and honestly report on how they are doing academically, socially, and emotionally
  • Must ask for help when it is needed
  • Should found and participate in a Mental Health Club, like LETS, to erase the stigma and receive support from their peers

Parents:
  • Should keep schools up-to-date on any changes in their child’s behavior, medications, etc.
  • Should advocate for their child when needed
  • Should support the school and work with their child on homework and life skills at home